The Optometric Nutrition Society (ONS)
held its Second Annual Education Symposium at the 2009 American Academy of
Optometry Meeting. The ONS assembled a panel of leaders in the field of
nutrition to provide its members with the latest research on dietary
alteration, vitamin E intake and nutraceuticals, as well as the optometric
benefits of physical activity and the systemic complications associated with
obesity.
Barrie Tan, PhD,
discussed the ocular and systemic benefits of increased vitamin E intake.
First, Floyd “Ski” Chilton, PhD,
discussed the contemporary obesity crisis in America and its direct association
with various genetic factors. In “You Can’t Change Your Genetic Destiny…Or Can
You,” Dr. Chilton suggested that many Americans possess particular genes that
inherently predispose them to obesity, heart disease and insulin resistance.
However, dietary alteration, calorie restriction and physical exercise can
markedly combat a genetic association with obesity.
“Obesity directly contributes to
systemic inflammation and oxidative stress,” Dr. Chilton said. “And now, we see
more heightened markers of systemic inflammation in America than ever before.”
Dr. Chilton championed the
implementation of a “gene smart diet” to reduce the likelihood of certain
chronic diseases related to inflammation, slow the aging process, and
accelerate weight loss.
The five principles of Dr. Chilton’s
gene smart diet include:
1. Increase polyphenol intake.
2. Balance the proportion of omega-3 and
omega-6 fatty acids.
3. Increase fiber intake.
4. Reduce caloric intake levels to
promote weight loss.
5. Increase exercise.
Next, Barrie Tan, PhD, delivered a presentation
entitled “The Many Faces of Vitamin E.” Dr. Tan discussed the role that tocotrienols,
a primary member of the vitamin E family, play in overall systemic health.
“Tocotrienol is one of the most powerful antioxidants in the world,” said Dr.
Tan. “Tocotrienol supplementation has been shown to dramatically reduce the
risk for arteriosclerosis, breast and pancreatic cancer, and diabetes.”
In addition to its systemic benefits,
Dr. Tan noted that the tocotrienols might prevent several ocular diseases, including
dry eye, diabetic retinopathy, macular degeneration, glaucoma and cataract.
Then, Hal Bohlman, OD, FAAO, discussed the importance of eliminating obesity in “Communicating the Ocular and Systemic Manifestations of Excess Weight.” Dr. Bohlman defined obesity as excess body fat relative to lean body mass. “Obesity affects ocular as well as systemic health,” he said. “Given our role in the patient’s well being, we cannot turn a blind eye to obese patients.” Dr. Bohlman outlined how obesity is directly and/or indirectly related to diabetic retinopathy, age-related macular degeneration, cataract formation and elevated intraocular pressure.
• Diabetic retinopathy. In addition to its
association with diabetes, obesity is a risk factor for the pathogenesis of
diabetic retinopathy and other microvascular abnormalities.
• AMD. Obesity increases the risk for
age-related macular degeneration due to several physiological changes,
including oxidative stress, alterations in the lipoprotein profile and
increased inflammation.
• Cataracts. “The Barbados Eye Study found that
high prevalence of cortical opacities was related to diabetes, hypertension and
abdominal obesity,” said Dr. Bohlman. “Interventions to modify these risk
factors, especially in high-risk populations, may help stem cataract-induced
vision loss.”
• Elevated IOP. Although there is no direct
association between glaucoma and obesity, Dr. Bohlman suggested that there is
an association between obesity and elevated intraocular pressure––a critical
risk factor for glaucoma.
“As primary health care providers, we
must understand how obesity affects our patients’ ocular health,” said Dr. Bohlman.
“It is equally important to educate overweight and obese patients about
healthier lifestyle choices, as these decisions will reduce their risk for
co-morbid ocular and systemic disease.”
Finally, Dr. Bohlman offered several
basic tips on how to provide adequate care for obese patients.
• Identify which patients require education and counseling about weight management. Acquire a scale and measure each patient’s weight and height. Additionally, include questions related to dietary and exercise habits in the patient’s history.
• Educate the patient about the ocular manifestations of obesity.
• Offer ideas about how to lose weight,
including dietary alteration, nutritional supplementation and increased
physical activity.
• Document the initial
discussion/consultation with your patient and follow-up with him or her at
subsequent appointments. Always remember to address any questions he or she
might pose.
This year's sponsors included Biosyntrx, Fortifeye, Marco Ophthalmic, Advanced Vision Research and Bausch & Lomb.
